Suprascapular nerve palsy following supraclavicular block for upper extremity surgery: report of 3 cases.

Regional anesthesia has become the preferred method of anesthesia for many upper extremity operations and generally results in decreased hospital stays, postoperative opioid requirement, and postoperative nausea. Complications of regional anesthesia are rarely reported in the literature, possibly because of limited anesthesiologist-patient follow-up. Three cases of suprascapular nerve palsy after ultrasound-guided supraclavicular nerve block for routine outpatient upper extremity surgery are reported. All cases occurred in men who originally presented with shoulder pain, which resolved with time, followed by weakness in the supraspinatus and infraspinatus, which improved over time but did not resolve. One case resulted in ipsilateral phrenic nerve palsy as well. A review of the literature on the subject accompanies the report of these 3 cases.

Complications of volar plate fixation for managing distal radius fractures.

Volar locking plate fixation via open reduction and internal fixation is an increasingly accepted method for managing displaced distal radius fractures. Volar plating offers biomechanically stable fixation, allows early rehabilitation, and enables fixation of comminuted or osteopenic bone. The literature reporting complications of volar plate fixation is limited primarily to case reports and small case series. The surgeon must be mindful of potential soft-tissue, neurovascular, and osseous complications, such as extensor tendon and flexor tendon injury, flexor pollicis rupture, carpal tunnel syndrome, complex regional pain syndrome, and loss of reduction, as well as hardware failure. Increased awareness of potential complications may lead to more prompt recognition and treatment when they do arise.

Early clinical experience with collagen nerve tubes in digital nerve repair.

PURPOSE: In cases of digital nerve injury in which nerve ends cannot be approximated without tension, autologous nerve grafts represent the most commonly used method for reconstruction. Recently, interest in synthetic nerve guides as an alternative to grafting has increased. Although several basic science studies have shown promise for collagen tubes, clinical studies of their success in humans are limited. The purpose of this study was to review our early clinical experience with collagen nerve tubes. METHODS: The authors identified and followed all cases involving digital nerve repair at our institution over a 2-year period. Twelve patients had repair of a digital nerve with a collagen nerve tube during the study period. Two patients were lost to follow-up, and 1 patient had amputation of the grafted finger secondary to complications of other injuries. The primary outcome data points for the remaining 9 patients were the static 2-point discrimination (2PD), Semmes-Weinstein monofilament testing, and a Quick Disabilities of the Arm, Shoulder, and Hand (DASH) outcome survey at final follow-up. RESULTS: Nine patients had follow-up of at least 1 year, with an average follow-up time of 15 months (range 12-22 months). There were no intraoperative or postoperative complications related to the nerve tubes. Using modified American Society for Surgery of the Hand guidelines, 2PD results were good or excellent in 8 out of 9 of patients. Semmes-Weinstein testing results were full in 5 patients, diminished light touch in 2, diminished protective sensation in 1, and loss of protective sensation in 1. Average Quick DASH scores for the group were 10.86 overall, 4.86 for the work module, and 23.21 for the sports/performing arts module. CONCLUSIONS: Although the patients in this study are still within the early follow-up period, our initial results compare favorably with those reported in the existing literature for various types of nerve repair and reconstruction, suggesting that collagen nerve tubes might offer a clinically effective option for restoration of sensory function. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Complications in dorsal percutaneous cannulated screw fixation of nondisplaced scaphoid waist fractures.

PURPOSE: With advances in tools and techniques, percutaneous screw fixation of nondisplaced fractures of the scaphoid waist has gained increasing popularity in recent years as an alternative to prolonged cast immobilization or open reduction and internal fixation. Many reports cite low complication rates, including no complications in some series. The purpose of this study was to evaluate the complications encountered with dorsal percutaneous cannulated screw fixation of nondisplaced scaphoid waist fractures. METHODS: A retrospective chart review was performed for 24 patients who had surgery performed by a single surgeon over a 5-year period. All cases involved dorsal percutaneous cannulated screw fixation of nondisplaced (<1 mm) fractures of the scaphoid waist. Complications were rated a priori as major or minor based on modifications of established criteria. RESULTS: The overall complication rate was 29%; there were 21% (5/24) major complications and 8% (2/24) minor complications. Major complications consisted of 1 case of nonunion, 3 cases involving hardware problems, and 1 case of postoperative fracture of the proximal pole of the scaphoid. Minor complications included intraoperative equipment breakage-1 case involving a screw and 1 case involving a guide wire. CONCLUSIONS: Complications in dorsal percutaneous cannulated screw fixation of scaphoid fractures may be more common than previously reported.

Complications after treatment of flexor tendon injuries.

The goals of flexor tendon repair are to promote intrinsic tendon healing and minimize extrinsic scarring in order to optimize tendon gliding and range of motion. Despite advances in the materials and methods used in surgical repair and postoperative rehabilitation, complications following flexor tendon injuries continue to occur, even in patients treated by experienced surgeons and therapists. The most common complication is adhesion formation, which limits active range of motion. Other complications include joint contracture, tendon rupture, triggering, and pulley failure with tendon bowstringing. Less common problems include quadriga, swan-neck deformity, and lumbrical plus deformity. Meticulous surgical technique and early postoperative tendon mobilization in a well-supervised therapy program can minimize the frequency and severity of these complications. Prompt recognition of problems and treatment with hand therapy, splinting, and/or surgery may help minimize recovery time and improve function. In the future, the use of novel biologic modulators of healing may nearly eliminate complications associated with flexor tendon injuries.

Infraspinatus muscle atrophy in professional baseball players.

BACKGROUND: Infraspinatus muscle atrophy has been observed in athletes who stress their upper extremities in an overhead fashion. The majority of such case reports have been in volleyball players, with far fewer cases reported in baseball players. HYPOTHESIS: Infraspinatus muscle atrophy occurs to a notable degree in professional baseball players. STUDY DESIGN: Retrospective cohort study. METHODS: At the end of the 1999 baseball season, data were collected from all Major League Baseball teams in regards to players affected with infraspinatus muscle atrophy. RESULTS: Twelve of the 1491 major league professional baseball players were identified as having appreciable infraspinatus muscle atrophy. There was an increased prevalence of the muscle atrophy in professional pitchers (10 of 494, 4%) compared to position players (2 of 997, 0.2%) (P <0.001). Among affected pitchers, the atrophy was identified more frequently in starting pitchers (8 of 10) compared to relief pitchers (2 of 10) (P = 0.036), pitchers who had played for more years at the major league level (8.7 +/- 4.9 versus 5.2 +/- 4.0) (P = 0.017), and pitchers who had thrown for more innings at the major league level (971.4 +/- 784.4 versus 485.0 +/- 594.6) (P <0.001). CONCLUSION: Infraspinatus atrophy was identified in 4.4% of major league starting pitchers and occurred in those pitchers who pitched for more years and innings during their major league career.

Thumb metacarpophalangeal joint arthrodesis using the AO 3.0-mm cannulated screw: surgical technique.

A technique for metacarpophalangeal joint arthrodesis of the thumb using the 3.0-mm AO cannulated screw is described. Advantages of this technique include its relative simplicity and accuracy, solid fixation, and high union rate.